anomalies and curiosities of medicine-第33部分

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nstant　death　resulting；　thirty　minutes　at　least　after　the　death　of　the　mother　an　infant　was　removed；　which；　after　some　difficulty；　was　resuscitated　and　lived　for　thirteen　years。　Tarnier　states　that　delivery　may　take　place　three…quarters　of　an　hour　or　even　an　hour　after　the　death　of　the　mother；　and　he　also　quotes　an　extraordinary　case　by　Hubert　of　a　successful　Cesarean　operation　two　hours　after　the　mother's　death；　the　woman；　who　was　eight　months　pregnant；　was　instantly　killed　while　crossing　a　railroad　track。


Hoffman　records　the　case　of　a　successful　Cesarean　section　done　ten　minutes　after　death。　The　patient　was　a　woman　of　thirty…six；　in　her　eighth　month　of　pregnancy；　who　was　suddenly　seized　with　eclampsia；　which　terminated　fatally　in　ten　hours。　Ten　minutes　after　her　last　respiration　the　Cesarean　section　was　performed　and　a　living　male　child　delivered。　This　infant　was　nourished　with　the　aid　of　a　spoon；　but　it　died　in　twenty…five　hours　in　consequence　of　its　premature　birth　and　enfeebled　vitality。

Green　speaks　of　a　woman；　nine　months　pregnant；　who　was　run　over　by　a　heavily　laden　stage…coach　in　the　streets　of　Southwark。　She　died　in　about　twenty　minutes；　and　in　about　twenty　minutes　more　a　living　child　was　extracted　from　her　by　Cesarean　section。　There　was　a　similar　case　in　the　Hopital　St。　Louis；　in　Paris；　in　1829；　but　in　this　case　the　child　was　born　alive　five　minutes　after　death。　Squire　tells　of　a　case　in　which　the　mother　died　of　dilatation　of　the　aorta；　and　in　from　twenty　to　thirty　minutes　the　child　was　saved。　In　comment　on　this　case　Aveling　is　quoted　as　saying　that　he　believed　it　possible　to　save　a　child　one　hour　after　the　death　of　the　mother。　No　less　an　authority　than　Playfair　speaks　of　a　case　in　which　a　child　was　born　half　an　hour　after　the　death　of　the　mother。　Beckman　relates　the　history　of　a　woman　who　died　suddenly　in　convulsions。　The　incision　was　made　about　five　minutes　after　death；　and　a　male　child　about　four　pounds　in　weight　was　extracted。　The　child　exhibited　feeble　heart…contractions　and　was　despaired　of。　Happily；　after　numerous　and　persistent　means　of　resuscitation；　applied　for　about　two　and　a　half　hours；　regular　respirations　were　established　and　the　child　eventually　recovered。　Walter　reports　a　successful　instance　of　removal　of　the　child　after　the　death　of　the　mother　from　apoplexy。

Cleveland　gives　an　account　of　a　woman　of　forty…seven　which　is　of　special　interest。　The　mother　had　become　impregnated　five　months　after　the　cessation　of　menstruation；　and　a　uterine　sound　had　been　used　in　ignorance　of　the　impregnation　at　this　late　period。　The　mother　died；　and　one　hour　later　a　living　child　was　extracted　by　Cesarean　section。　There　are　two　other　recent　cases　recorded　of　extraction　after　an　hour　had　expired　from　the　death。　One　is　cited　by　Veronden　in　which　the　extraction　was　two　hours　after　death；　a　living　child　resulting；　and　the　other　by　Blatner　in　which　one　hour　had　elapsed　after　death；　when　the　child　was　taken　out　alive。

Cases　of　rupture　of　the　uterus　during　pregnancy　from　the　pressure　of　the　contents　and　delivery　of　the　fetus　by　some　unnatural　passage　are　found　in　profusion　through　medical　literature；　and　seem　to　have　been　of　special　interest　to　the　older　observers。　Benivenius　saw　a　case　in　which　the　uterus　ruptured　and　the　intestines　protruded　from　the　vulva。　An　instance　similar　to　the　one　recorded　by　Benivenius　is　also　found　in　the　last　century　in　Germany。　Bouillon　and　Desbois；　two　French　physicians　of　the　last　century；　both　record　examples　of　the　uterus　rupturing　in　the　last　stages　of　pregnancy　and　the　mother　recovering。　Schreiber　gives　an　instance　of　rupture　of　the　uterus　occasioned　by　the　presence　of　a　13…pound　fetus；　and　there　is　recorded　the　account　of　a　rupture　caused　by　a　20…pound　fetus　that　made　its　way　into　the　abdomen。　We　find　old　accounts　of　cases　of　rupture　of　the　uterus　with　birth　by　the　umbilicus　and　the　recovery　of　the　woman。　Vespre　describes　a　case　in　which　the　uterus　was　ruptured　by　the　feet　of　the　fetus。

Farquharson　has　an　account　of　a　singular　case　in　midwifery　in　which　abdomen　ruptured　from　the　pressure　of　the　fetus；　and　quite　recently　Geoghegan　illustrates　the　possibilities　of　uterine　pressure　in　pregnancy　by　a　postmortem　examination　after　a　fatal　parturition；　in　which　the　stomach　was　found　pushed　through　the　diaphragm　and　lying　under　the　left　clavicle。　Heywood　Smith　narrates　the　particulars　of　a　case　of　premature　labor　at　seven　months　in　which　rupture　of　the　uterus　occurred　and；　notwithstanding　the　fact　that　the　case　was　complicated　by　placenta　praevia；　the　patient　recovered。

Rupture　of　the　uterus　and　recovery　does　not　necessarily　prevent　subsequent　successful　pregnancy　and　delivery　by　the　natural　channels。　Whinery　relates　an　instance　of　a　ruptured　uterus　in　a　healthy　Irish　woman　of　thirty…seven　from　whom　a　dead　child　was　extracted　by　abdominal　section　and　who　was　safely　delivered　of　a　healthy　female　child　about　one　year　afterward。　Analogous　to　this　case　is　that　of　Lawrence；　who　details　the　instance　of　a　woman　who　had　been　delivered　five　times　of　dead　children；　she　had　a　very　narrow　pelvis　and　labor　was　always　induced　at　the　eighth　month　to　assure　delivery。　In　her　sixth　pregnancy　she　had　miscalculated　her　time；　and；　in　consequence；　her　uterus　ruptured　in　an　unexpected　parturition；　but　she　recovered　and　had　several　subsequent　pregnancies。

Occasionally　there　is　a　spontaneous　rupture　of　the　vagina　during　the　process　of　parturition；　the　uterus　remaining　intact。　Wiltshire　reports　such　a　case　in　a　woman　who　had　a　most　prominent　sacrum；　the　laceration　was　transverse　and　quite　extensive；　but　the　woman　made　a　good　recovery。　Schauta　pictures　an　exostosis　on　the　promontory　of　the　sacrum。　Blenkinsop　cites　an　instance　in　which　the　labor　was　neither　protracted　nor　abnormally　severe；　yet　the　rupture　of　the　vagina　took　place　with　the　escape　of　the　child　into　the　abdomen　of　the　mother；　and　was　from　thence　extracted　by　Cesarean　section。　A　peculiarity　of　this　case　was　the　easy　expulsion　from　the　uterus；　no　instrumental　or　other　manual　interference　being　attempted　and　the　uterus　remaining　perfectly　intact。

In　some　cases　there　is　extensive　sloughing　of　the　genitals　after　parturition　with　recovery　far　beyond　expectation。　Gooch　mentions　a　case　in　which　the　whole　vagina　sloughed；　yet　to　his　surprise　the　patient　recovered。　Aetius　and　Benivenius　speak　of　recovery　in　such　cases　after　loss　of　the　whole　uterus。　Cazenave　of　Bordeaux　relates　a　most　marvelous　case　in　which　a　primipara　suffered　in　labor　from　an　impacted　head。　She　was　twenty…five；　of　very　diminutive　stature；　and　was　in　labor　a　long　time。　After　labor；　sloughing　of　the　parts　commenced　and　progressed　to　such　an　extent　that　in　one　month　there　were　no　traces　of　the　labia；　nymphae；　vagina；　perineum；　or　anus。　There　was　simply　a　large　opening　extending　from　the　meatus　urinarius　to　the　coccyx。　The　rectovaginal　septum；　the　lower　portion　of　the　rectum；　and　the　neck　of　the　bladder　were　obliterated。　The　woman　survived；　although　she　always　experienced　great　difficulty　in　urination　and　in　entirely　emptying　the　rectum。　A　similar　instance　is　reported　in　a　woman　of　thirty　who　was　thirty…six　hours　in　labor。　The　fundus　of　the　uterus　descended　into　the　vagina　and　the　whole　uterine　apparatus　was　removed。　The　lower　part　of　the　rectum　depended　between　the　labia；　in　the　presence　of　the　physician　the　nurse　drew　this　out　and　it　separated　at　the　sphincter　ani。　On　examining　the　parts　a　single　opening　was　seen；　as　in　the　preceding　case；　from　the　pubes　to　the　coccyx。　Some　time　afterward　the　end　of　the　intestine　descended　several　inches　and　hung　loosely　on　the　concave　surface　of　the　rectum。　A　sponge　was　introduced　to　support　the　rectum　and　prevent　access　of　air。　The　destruction　of　the　parts　was　so　complete　and　the　opening　so　large　as　to　bring　into　view　the　whole　inner　surface　of　the　pelvis；　in　spite　of　which；　after　prolonged　suppuration；　the　wound　cicatrized　from　behind　forward　and　health　returned；　except　as　regards　the　inconvenience　of　feces　and　urine。　Milk…secretion　appeared　late　and　lasted　two　months　without　influencing　the　other　functions。

There　are　cases　in　which；　through　the　ignorance　of　the　midwife　or　the　physician；　prolapsed　pelvic　organs　are　mistaken　for　afterbirth　and　extracted。　There　have　been　instances　in　which　the　whole　uterus　and　its　appendages；　not　being　recognized；　have　been　dragged　out。　Walters　cites　the　instance　of　a　woman　of　twenty…two；　who　was　in　her　third　confinement。　The　midwife　in　attendance；　finding　the　afterbirth　did　not　come　away；　pulled　at　the　funis；　which　broke　at　its　attachment。　She　then　introduced　her　hand　and　tore　away　what　proved　to　be　the　whole　of　the　uterus；　with　the　right　ovary　and　fallopian　tube；　a　portion　of　the　round　ligament；　and　the　left　tube　and　ovarian　ligament　attached　to　it。　A　large　quantity　of　omentum　protruded　from　the　vulva　and　upper　part　of　the　vagina；　and　an　enormous　rent　was　left。　Walters　saw　the　woman　twenty…one　hours　afterward；　and　ligated　and　severed　the　protruding　omentum。　On　the　twenty…eighth　day；　after　a　marvelous　recovery；　she　was　able　to　drive　to　the　Royal　Berkshire　Hospital；　a　distance　of　five　miles。　At　the　time　of　report；　two　years　and　six　months　after　the　mutilation；　she　was　in　perfect　health。　Walters　looked　into　the　statistics　of　such　cases　and　found　36　accidental　removals　of　the　uterus　in　the　puerperium　with　14　recoveries。　All　but　three　of　these　were　without　a　doubt　attended　by　previous　inversion　of　the　uterus。

A　medical　man　was　tried　for　manslaughter　in　1878　because　he　made　a　similar　mistake。　He　had　delivered　a　woman　by　means　of　the　forceps；　and；　after　delivery；　brought　away　what　he　thought　a　tumor。　This　〃tumor〃　consisted　of　the　uterus；　with　the　placenta　attached　to　the　fundus；　the　funis；　a　portion　of　the　lateral　ligament；　containing　one　ovary　and　about　three　inches　of　vagina。　The　uterus　was　not　inverted。　A　horrible　case；　with　similar　results；　happened　in　France；　and　was　reported　by　Tardieu。　A　brutal　peasant；　whose　wife　was　pregnant；　dragged　out　a　fetus　of　seven　months；　together　with　the　uterus　and　the　whole　intestinal　canal；　from　within　50　cm。　of　the　pylorus　to　within　8　cm。　of　the　ileocecal　valve。　The　woman　was　seen　three…quarters　of　an　hour　after　the　intestines　had　been　found　in　the　yard　（where　the　brute　had　thrown　them）；　s